Symposium: Div. 17 Special Section - Health Psychology

1. Symposium:Div. 17 Special Section - Health Psychology “Preparing Students for New Roles in Integrated Health: The Evolving Interface of Counseling and Health Psychology”

2. Participants • Chair: Brian L. Lewis, Ph.D. – Salem VA Medical Center • Donald R. Nicolas, Ph.D. - Ball State University • Annette Kluck, Ph.D. & Daniel Stabin, M.A. - Auburn University • Sarah Hastings, Ph.D. & Tracy Jay Cohn, Ph.D. - Radford University • Mary Ann Hoffman, Ph.D. - University of Maryland

3. Recent Health Care Developments and their Implications for Training in Counseling Psychology Donald R. Nicholas, PhD Dept. of Counseling Psychology Ball State University

4. Change is under way and on the way. . . . . health care reform (ACA)  accountability for effective (evidence-based) & cost efficient care  change in health care delivery systems (PCMHs, ACOs)  credentialing/privileging to identify highest quality providers  change in education/training  health service psychology, competency movement, accreditation (program, internship, postdoc) and board certification (ABPP)  specialty recognition  taxonomy of terms

5. the confusing terminology of change health service psychology medical home PCMHs emphasis ACA interprofessional competence integrative care taxonomy ACOs exposure experience major area of study

6. Health Service Psychology Health Service Psychology Education Collaborative (HSPEC) Given that professional psychology includes diverse areas of practice and the mounting concerns about psychology’s role in a reformed health care system, HSPEC chose to focus on preparation of psychologists for the delivery of health care services and made seven recommendations that constitute the core of a blueprint for the future. (HSPEC, 2013)

12. Why the change? --- Health Care Reform

14. Affordable Care Act (ACA) • Economist Jonathan Gruber - brief explanation • http://www.youtube.com/watch?v=IF8SiN8Bbh0

15. Some Implications for Counseling Psychology Affordable Care = Accountable Care • Accountability in health care • effective (evidence-based) and cost efficient care • To do so will effect psychologists • settings & forms of practice • processes of credentialing & privileging • education and training

16. ACA & implications for practice settings Patient Protection and Affordable Care Act (ACA; Public Law No: 111-148, Mar 23, 2010:), … will continue to focus on the growing expectation that interprofessional healthcare organizations (that is, patient center healthcare homes & accountable care organizations) will become the nexus of the delivery of efficient, cost effective, and quality healthcare services. (Rozensky, 2014, APA Convention, Hawaii)

17. Interprofessional health care delivery organizations • Patient Centered Healthcare (Medical) Home • proposed since 1967 by American Academy of Pediatrics Accepted 1990s • A model of care in which “patients have a direct relationship with a provider who coordinates a cooperative team of healthcare professionals, takes collective responsibility for the care provided and arranges opportunities for other qualified professionals as needed… • Interprofessional Collaboration

18. Interprofessional Collaboration • “Interprofessionalism involves the development of competencies across disciplines and the application of those shared competencies in an integrated, team based health care system…. • Rozensky & Janicke, 2011

19. IPEC

20. Interprofessional Collaborative Practice • “When multiple health workers from different professional backgrounds work together with patients, families, carers [sic], and communities to deliver the highest quality of care” (WHO, 2010)

21. Interprofessional team based care • Care delivered by intentionally created, usually relatively small work groups in health care, who are recognized by others as well as by themselves as having a collective identity and shared responsibility for a patient or group of patients, e.g., rapid response team, palliative care team, primary care team, operating room team (IPEC, 2011).

22. ACA and Diversity • IOM identified INSURANCE as key factor for quality of health / health disparities • Uninsured….. • 1 out of 3 Hispanics/ Latinos and American Indians • 1 out of 5 African Americans • 1 out of 8 White Americans Dr. Garden Grant/ Minority Health 2012

23. Practice of Health Service Psychology • In this era of health care reform (ACA), with its focus on accountability, evidence-based and cost-efficient practice, health service psychologists (counseling, clinical, school) will practice in settings where interprofessional collaboration is essential/expected. • How does one become a member of an interprofessional team?

25. Credentialing and Privileging • Health care providers do not just walk into an organized healthcare facility and just see their patients. They must have permission to see patients as members of the professional staff (Stromberg et al., 1988, p 329)

26. Credentialing • Defined as the process of obtaining, verifying and assessing the qualifications of a health care practitioner to provide patient care services in or for a health care organization. • Credentialing of professional staff assures that systems of care only include the highest qualified providers as part of their system of care

27. Credentialing and Training • That is, credentialing will require graduation from accredited education and training programs which suggests that providers have met (at least minimal) defined standards of training (Rozensky, 2011). • increasing expectation of specialty board certification — already routine expectations of hospital-based healthcare providers on the “professional staff” (Rozensky, 2012). • American Board of Professional Psychology (ABPP)

28. Privileging • Defined as the process whereby a specific scope and content of patient care services (i.e., clinical privileges) are authorized for a health care practitioner by a health care organization, based on evaluation of the credentials and performance • practice organizations regularly and routinely require evidence of competence to maintain clinical privileges – re-credentialed every xxx years

29. Education & Training • (HSPEC) Blueprint • 7 recommendations • Multiple competencies • Counseling Psychology • Psychology Practice in Primary Care • Patient Centered Medical Home • Interprofessional/integrative/collaborative care • APAs Specialties Taxonomy

30. HSPEC 7 issues addressed: 1: The competencies . . . should be clearly articulated and understood by all . . 2: There should be guidelines for minimal qualifications to enter doctoral programs . . . 3: Psychology needs to articulate and evaluate the competencies for each level in the sequence of education and training . . . 4: There needs to be increased focus on competency assessment in health service psychology education and training . . . 5: The future of health service psychology rests on the integration of science and practice. 6: Psychology needs to establish the standard of self-regulation for education and training in the profession. 7: Psychology needs more research relevant to the preparation and roles of health service psychologists and must have . . . workforce analysis.

31. Multiple Competencies: Resources • http://www.apa.org/ed/graduate/competency.aspx • A Practical Guidebook for the Competency Benchmarks (July 2012) 
New guidebook that provides practical information on implementing a competency-based approach to education and training • Final Report of the APA Task Force on the Assessment of Competence in Professional Psychology, October 2006 • Revised Competency Benchmarks for Professional Psychology (June 2011) (DOC, 239KB)

32. Competencies Resources • Counseling psychology competencies rationale statement. CCPTP website. • Overview of counseling psychology competencies and essential components. CCPTP website. • Counseling psychology core competencies, essential components, behavioral anchors and examples. CCPTP website • Competencies for Psychology Practice in Primary Care Report of the Interorganizational Work Group on Competencies for Primary Care Psychology Practice, APA, March 2013.

33. What is a specialty? truth in advertising & the need for a taxonomy • If specialties are becoming essential and PCMHs and ACOs are going to be credentialing and privileging providers, consistency in terminology is needed. • The CRSPPP Taxonomy

34. Commission for the Recognition of Specialties in Professional psychology (CRSPPP) Taxonomy

35. 13 APA Recognized Specialties in Health Service Psychology • Behavioral and Cognitive • Clinical Child • Counseling • Clinical Neuropsychology • Clinical Health • Clinical • Forensic • Family • Psychoanalysis • School • Prof. Geropsychology • Police and Public Safety • Sleep

37. so what am I getting in my doctoral program? • Specialty in Counseling Psychology with a _________________ in _________________ • major area of study ----- 2-3 yrs didactics and a dissertation or research project • emphasis ----- at least 4 courses and 2 practica • experience ----- at least 1-2 courses and 1 practicum • exposure ----- at least 1-2 courses • anything else is a focus • only applicable to the 13 recognized specialties

38. References • Rozensky, Ronald H. (2011). The institution of the institutional practice of psychology: Health care reform and psychology's future workforce. American Psychologist, 66(8), 797-808. doi: 10.1037/a0025074 • Rozensky, Ronald H., Celano, Marianne, & Kaslow, Nadine. (2013). Implications of the Affordable Care Act for the practice of family psychology. Couple and Family Psychology: Research and Practice, 2(3), 163-178. doi: 10.1037/cfp0000009 • Rozensky, Ronald H., Grus, Catherine L., Belar, Cynthia D., Nelson, Paul D., & Kohout, Jessica L. (2007). Using workforce analysis to answer questions related to the internship imbalance and career pipeline in professional psychology. Training and Education in Professional Psychology, 1(4), 238-248. doi: 10.1037/1931-3918.1.4.238 • Rozensky, Ronald H., & Janicke, David M. (2012). Commentary: Healthcare reform and psychology's workforce: Preparing for the future of pediatric psychology. Journal of Pediatric Psychology, 37(4), 359-368. doi: 10.1093/jpepsy/jsr111

39. References • Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative. • American Psychological Association. (2012). Education and training guidelines: A taxonomy for education and training in professional psychology health service specialties. Retrieved from http://www.apa.org/ed/graduate/specialize/taxonomy.pdf • Rodolfa, Emil, Bent, Russ, Eisman, Elena, Nelson, Paul, Rehm, Lynn, & Ritchie, Pierre. (2005). A Cube Model for Competency Development: Implications for Psychology Educators and Regulators. Professional Psychology: Research and Practice, 36(4), 347-354. • Rozensky, Ronald H. (2012). Health care reform: Preparing the psychology workforce. Journal of Clinical Psychology in Medical Settings, 19(1), 5-11. doi: 10.1007/s10880-011-9287-7

40. References • Beacham, Abbie O., Kinman, Carissa, Harris, Josette G., & Masters, Kevin S. (2012). The patient-centered medical home: Unprecedented workforce growth potential for professional psychology. Professional Psychology: Research and Practice, 43(1), 17-23. doi: 10.1037/a0025320 • Hatcher, Robert L., Fouad, Nadya A., Campbell, Linda F., McCutcheon, Stephen R., Grus, Catherine L., & Leahy, Kerry L. (2013). Competency-based education for professional psychology: Moving from concept to practice. Training and Education in Professional Psychology, 7(4), 225-234. doi: 10.1037/a0033765 • Nash, Justin M., Khatri, Parinda, Cubic, Barbara A., & Baird, Macaran A. (2013). Essential competencies for psychologists in patient centered medical homes. Professional Psychology: Research and Practice, 44(5), 331-342. doi: 10.1037/a0033106 • Nicholas, Donald R., & Stern, Marilyn. (2011). Counseling psychology in clinical health psychology: The impact of specialty perspective. Professional Psychology: Research and Practice, 42(4), 331-337. doi: 10.1037/a0024197 • Schaffer, Jack B., Rodolfa, Emil R., Hatcher, Robert L., & Fouad, Nadya A. (2013). Professional psychology competency initiatives: Reflections, contrasts, and recommendations for the next steps. Training and Education in Professional Psychology, 7(2), 92-98. doi: 10.1037/a0032038

41. Health Psychology in Counseling Psychology Academic Training Programs: What Are Faculty and Trainees Doing? Annette S. Kluck, Ph.D. Daniel Stabin, M.A. Auburn University

42. Counseling Health Psychology Recent push in APA focuses on Health Service Psychologists • APA recognizes that Counseling Psychologists can contribute to health services beyond mental health (APA, 1996, 2011) • APA’s public definition of counseling psychologists lists among the problems we treat: helping people adapt to physical disabilities, diseases, or injury (APA, 2013) • Division 17 definition includes attention paid to health-related concerns (SCP, 2014)

43. What Happens in Our Programs? This should translate to the practice of health psychology activities among counseling psychology students and the faculty that train them Existing research documents general trends of an interest in counseling psychology among students and faculty There appear to be a subset of counseling psychology division members who also hold membership in the health psychology division (Nicholas & Stern, 2011) Core areas of competence for counseling health psychologists can be identified (Nicholas & Stern, 2011) We sought to examine how this relates to the future of the field and current program activity

44. Survey of Programs Based on study by Raque-Bogdan, Torrey, Lewis, & Borges (2012), we can generally assume the following about Counseling Psychology programs Less than a fifth of programs were particularly known for subspecialty in health psychology or primary care Over half have no formal specialty track/concentration/minor In most programs that lack formal training, it would be somewhat difficult to impossible to offer formal coursework in health psychology Training directors indicated that there is some interest in health psychology among students Majority of programs with students interested in health psychology have one or no faculty members with expertise

45. Faculty Job Openings Reviewed classified ads from the Monitor on Psychology from May 2011 to March 2014 • Imperfect data source • Not all programs advertise in the magazine • Same job advertised across multiple issues • Programs do not always list everything they are considering or wanting • Programs may not list the exact number of positions • Program alignment is no always clear in ads

46. Faculty Job Openings Who is in the data? • We included new programs known to be seeking accreditation and participation in CCPTP • We did not include ads that suggested the position was for another program in the department • We included ads for positions in departments with counseling psychology programs • Department head positions • Open lines to contribute to any program

47. Faculty Job Openings Who are we trying to hire in APA-accredited programs • 39 advertised positions • 8 explicitly mentioned interest in filling position with someone with health psychology focus • 10 of the 39 were for admin (head/dean) slots • Translates to 20.5% of positions • Relative to current proportion of faculty with health psychology expertise, there is a trend to advertise for health psychology expertise among non-administrative faculty lines

48. Counseling Psychology Faculty Grants Examined grants held by counseling psychology faculty reported in the Insider’s guide to graduate programs in clinical and counseling psychology: 2012/2013 edition (Norcross & Sayette, 2013) • A source that can be used for recruiting • Applicants may review to find faculty research interests and programs that match what they desire • Training directors were given opportunity to update the data to reflect current program activity

49. Counseling Psychology Faculty Grants • 51 total grants at 28 counseling psychology programs • 26 grants listed as explicitly focused on health • 8 others might have a health focus • 16 of the 28 programs had a least 1 grant explicitly linked to health psychology • Based on proportion of faculty with health psych expertise (Raque-Bogdan et al., 2012), significantly greater portion of grants have health psych focus (p < .001)

50. Counseling Psychology Student Interests Based on existing research(Raque-Bogdan et al., 2012), • Most programs have at least some students who are at least somewhat interested in health psychology • Over half of programs have at least some opportunity for practicum training in a health psychology setting • A minority of graduates go on to a health psychology position after completion of their degree